背景:跌倒是老年人中最常见的药物相关安全事件。取消处方增加跌倒风险的药物(FRID)可以减轻跌倒风险。这项研究评估了一项创新的开处方计划在减少FRID负担和与跌倒相关的急性就诊超过1年的效果。
方法:老年人药物下降评估(FAME)计划是一项试点开药计划,旨在提高65岁以上退伍军人的用药安全性,在达勒姆退伍军人事务医疗保健系统中筛查高跌倒风险呈阳性。一个跨学科小组完成了中央病例发现和电子病例审查,并提出了取消处方的建议。转发给处方者以供批准,然后在FAME团队的后续电话访问中实施。主要结果是1年时通过改良药物负担指数(DBI)计算的FRID负担变化,探索性结果是1年与跌倒相关的急性就诊。
结果:总体而言,472例患者(236例干预,236个匹配的对照)被包括在研究中。在接受FAME取消处方计划的236名患者中,147的建议得到了处方者和患者的批准。在意向治疗分析中,在干预队列中,改良DBI的1年变化为-0.15(95%CI-0.23,-0.08),在匹配的对照组中为-0.11(-0.21,-0.00)(p=0.47).在FAME队列中,DBI增加临床重要阈值0.5的几率显着降低(OR0.37、0.21、0.66)。在一年的时间内,干预组中有6.3%的患者发生了与跌倒相关的急性事件,对照组为11.0%(p=0.10)。
结论:与匹配的对照组相比,该方案在1年时进一步增加FRID负担的几率显著降低。电子病例审查和电话咨询计划有可能减少高风险老年人与药物相关的跌倒。
Falls are the most common medication-related safety event in older adults. Deprescribing fall risk-increasing drugs (FRIDs) may mitigate fall risk. This study assesses the effects of an innovative deprescribing program in reducing FRID burden and falls-related acute visits over 1 year.
The Falls Assessment of Medications in the Elderly (FAME) Program is a pilot deprescribing program designed to improve medication safety in Veterans aged ≥65, screening positive for high fall risk at the Durham Veterans Affairs Health Care System. Central
case finding and electronic
case reviews with deprescribing recommendations were completed by an interdisciplinary team, forwarded to prescribers for approval, then implemented during follow-up telephone visits by FAME team. Primary outcome was change in FRID burden calculated by modified Drug Burden Index (DBI) at 1 year and an exploratory outcome was 1-year fall-related acute visits.
Overall, 472 patients (236 intervention cases, 236 matched controls) were included in the study. Of the 236 patients receiving a FAME deprescribing plan, 147 had recommendations approved by prescriber and patient. In the intention-to-treat analysis, the 1-year change in modified DBI was -0.15 (95% CI -0.23, -0.08) in the intervention cohort and -0.11 (-0.21, -0.00) in the matched control cohort (p = 0.47). The odds of increasing DBI by a clinically important threshold of 0.5 was significantly lower in the FAME cohort (OR 0.37, 0.21, 0.66). Fall-related acute events occurred in 6.3% of patients in the intervention group versus 11.0% in control patients over a one-year period (p = 0.10).
The program was associated with a significantly lower odds of further increasing FRID burden at 1 year compared to matched controls. An electronic
case review and telephone counseling program has the potential to reduce drug-related falls in high-risk older adults.